Author(s): Iuppa CA, Nelson LA, Elliott E, Sommi RW
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Abstract BACKGROUND: There is a paucity of information regarding adverse drug reactions (ADRs) in psychiatric patients. Information on common and preventable ADRs (pADRs) in psychiatric patients will allow for targeted improvement projects. OBJECTIVE: To characterize reported ADRs and pharmacist interventions to prevent ADRs in an extended-care state psychiatric hospital. METHODS: Four years of ADR reports were assessed for probability, reaction severity, pharmacological class of medication involved, preventability, change in therapy, and transfers to a medical facility. The pharmacist intervention database was queried for interventions classified as "prevention of ADR." The interventions were assessed for type of medication and recommendation acceptance. RESULTS: Medication classes responsible for ADRs included mood stabilizers (30\%), typical antipsychotics (25\%), atypical antipsychotics (25\%), and antidepressants (8\%). Nine percent resulted in transfer to a medical facility. Of all ADRs, 34.4\% were pADRs; mood stabilizers (41\%) and atypical antipsychotics (27\%) were the most common pADRs. The most common causes of pADRs were supratherapeutic serum concentrations, drug-drug interactions, and history of reaction. There were 87 pharmacist interventions that were classified as "prevention of ADR," and the acceptance rate of pharmacists' recommendations was 96.5\%. Mood stabilizers (20\%), atypical antipsychotics (17\%), and typical antipsychotics (11\%) were commonly associated with prevented ADRs. Lithium accounted for 13.8\% of prevented ADRs; these ADRs were most often due to a drug-drug interaction with a nonsteroidal anti-inflammatory drug. CONCLUSIONS: ADRs were most commonly associated with mood stabilizers and antipsychotics, and pADRs were common. There is an opportunity to provide education to medical staff on therapeutic drug monitoring and drug-drug interactions for these classes, particularly lithium.
This article was published in Hosp Pharm
and referenced in Journal of Clinical & Experimental Pharmacology